Effect of pre-transplantation prednisone on survival after lung transplantation

It is routine practice to discontinue corticosteroids or at least reduce the dose to

Between November 1990 and January 2005, 201 patients underwent lung transplantation. Of these, 126 patients had been prescribed prednisone before lung transplantation. Sixty-four had taken low-dose (LD) prednisone (<0.42 mg/kg/m(2) per day), and 62 had taken high-dose (HD) prednisone (>or=0.42 mg/kg/m(2) per day). The LD Group also included 75 patients never prescribed steroids before lung transplantation (n = 139).

A comparison of survival rates between LD and HD Cohorts showed better survival in the LD group, p value by log rank for LD vs HD <0.01. Other than having more emphysema patients (53/139, 40%) and fewer idiopathic pulmonary fibrosis patients (21/139, 16%) in the LD group (p < 0.01), pre-transplantation characteristics between the 2 cohorts were similar. In addition, the LD Group had more bilateral lung recipients (p < 0.01). During the first 100 days after transplantation, 20 HD (20/62) patients and 16 LD (16/139) died (p < 0.01).

Survival in the LD Cohort was strikingly better than for patients receiving >or=0.42 mg/kg/m(2) per day. Deaths in the early post-operative period for the HD Group may be related to steroid-induced complications such as poor wound healing and serious infections. A pre-lung transplantation steroid dose adjusted for body mass index of >or=0.42 mg/kg/m(2) per day may be associated with increased complications and worse survival after lung transplantation. Further studies are warranted to confirm these results.